ABSTRACT
La esclerosis lateral amiotrófica es una enfermedad crónica y neurodegenerativa del sistema nervioso central que afecta a las motoneuronas, produciendo debilidad muscular progresiva, que conduce a una atrofia y una parálisis muscular, y finalmente a la muerte. La realización de una gastrostomía endoscópica percutánea con sedación en los pacientes afectos de esclerosis lateral amiotrófica puede ser un reto para el anestesiólogo. Presentamos el caso de un paciente de 76 años afecto de esclerosis lateral amiotrófica en estadio avanzado, ASA III, en el que se realizó una gastrostomía endoscópica percutánea con sedación profunda, para lo que se empleó ventilación mecánica no invasiva como soporte respiratorio, para evitar la hipoventilación y las complicaciones respiratorias postoperatorias (AU)
Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications (AU)
Subject(s)
Aged , Humans , Male , Gastrostomy/instrumentation , Gastrostomy/methods , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Respiration, Artificial , Conscious Sedation/methods , Amyotrophic Lateral Sclerosis/drug therapy , Riluzole/therapeutic use , Amyotrophic Lateral Sclerosis/metabolism , Amyotrophic Lateral Sclerosis/surgery , Chronic Disease/drug therapy , Endoscopy/methods , Postoperative Complications/prevention & control , Muscle Weakness/drug therapy , Anesthesia/methodsABSTRACT
Amyotrophic lateral sclerosis is a chronic neurodegenerative disease of the central nervous system which affects the motor neurons and produces a progressive muscle weakness, leading to atrophy and muscle paralysis, and ultimately death. Performing a percutaneous endoscopic gastrostomy with sedation in patients with amyotrophic lateral sclerosis can be a challenge for the anesthesiologist. The case is presented of a 76-year-old patient who suffered from advanced stage amyotrophic lateral sclerosis, ASA III, in which a percutaneous endoscopic gastrostomy was performed with deep sedation, for which non-invasive ventilation was used as a respiratory support to prevent hypoventilation and postoperative respiratory complications.
Subject(s)
Amyotrophic Lateral Sclerosis/surgery , Gastroscopy/methods , Gastrostomy , Masks , Noninvasive Ventilation/methods , Aged , Deep Sedation , Equipment Design , Humans , Male , Muscle Weakness/etiology , Muscle Weakness/physiopathology , Noninvasive Ventilation/instrumentation , Postoperative Complications/prevention & control , Respiratory Muscles/physiopathologyABSTRACT
Se describe el procedimiento anestésico en dos pacientes obesos con broncopatía crónica obstructiva que se llevó a cabo mediante la combinación de anestesia epidural y ventilación no invasiva. Esta técnica permitió evitar la intubación, la anestesia general y complicaciones pulmonares perioperatorias(AU)
We report two cases of anesthesia for radical retropubic prostatectomy (RRP) in obese-chronic obstructive pulmonary disease (COPD) patients using the combination of epidural anesthesia and non-invasive ventilation (NIV). This technique avoided intubation, general anesthesia and perioperative pulmonary complications(AU)
Subject(s)
Humans , Male , Anesthesia, Epidural/instrumentation , Anesthesia, Epidural/methods , Anesthesia, Epidural , Prostatectomy/methods , Respiration, Artificial/instrumentation , Respiration, Artificial/methods , Pulmonary Disease, Chronic Obstructive/drug therapy , Anesthesia, Epidural/trends , Obesity/complications , Obesity/diagnosis , Respiration, Artificial/trends , Respiration, Artificial , Pulmonary Disease, Chronic Obstructive/therapy , Pulmonary Disease, Chronic ObstructiveABSTRACT
We report two cases of anesthesia for radical retropubic prostatectomy (RRP) in obese-chronic obstructive pulmonary disease (COPD) patients using the combination of epidural anesthesia and non-invasive ventilation (NIV). This technique avoided intubation, general anesthesia and perioperative pulmonary complications.
Subject(s)
Anesthesia, Epidural , Noninvasive Ventilation , Obesity/complications , Prostatectomy , Pulmonary Disease, Chronic Obstructive/complications , Aged , Humans , Male , Middle AgedSubject(s)
Anesthesia, Epidural/adverse effects , Apnea/etiology , Atrial Premature Complexes/etiology , Cough/etiology , Fibromatosis, Aggressive/surgery , Heart Atria/pathology , Heart Neoplasms/complications , Intraoperative Complications/etiology , Myxoma/complications , Postoperative Complications/surgery , Skin Neoplasms/surgery , Syncope/etiology , Adult , Atrial Premature Complexes/physiopathology , Cicatrix/surgery , Cough/physiopathology , Female , Heart Atria/diagnostic imaging , Heart Atria/surgery , Heart Neoplasms/diagnostic imaging , Heart Neoplasms/surgery , Humans , Incidental Findings , Intraoperative Complications/physiopathology , Myxoma/diagnostic imaging , Myxoma/surgery , Recurrent Laryngeal Nerve/physiopathology , Supine Position/physiology , Syncope/physiopathology , Ultrasonography , Ventricular Premature Complexes/etiology , Ventricular Premature Complexes/physiopathologyABSTRACT
No disponible
Subject(s)
Humans , Female , Adult , Myxoma/complications , Anesthesia, Spinal/adverse effects , Fibroma, Desmoplastic/surgery , Cough/etiology , Syncope/etiology , Tachycardia, Supraventricular/etiology , Respiratory Insufficiency/etiologyABSTRACT
Noninvasive ventilation (NIV) can be useful to anesthesiologists working in critical care units, postanesthesia recovery units, operating theaters, or other settings. NIV can help in situations of acute respiratory failure or serve as a preventive measure in patients undergoing interventions under local-regional anesthesia or diagnostic or therapeutic procedures requiring sedation. Successful NIV depends on adequately trained health personnel and the proper choice of material (interfaces, respirators, etc.) for each setting where this modality is used.
Subject(s)
Anesthesia Recovery Period , Anesthesiology/methods , Intraoperative Care/methods , Postoperative Care/methods , Respiration, Artificial/methods , Acute Disease , Anesthesia, Spinal , Bronchoscopy , Catheter Ablation , Continuous Positive Airway Pressure , Fiber Optic Technology , Gastroscopy , Humans , Intensive Care Units , Intraoperative Complications/therapy , Intubation, Intratracheal , Nerve Block , Postoperative Complications/therapy , Pulmonary Disease, Chronic Obstructive/complications , Recovery Room , Respiration, Artificial/instrumentation , Respiration, Artificial/nursing , Respiratory Insufficiency/therapyABSTRACT
La ventilación mecánica no invasiva (VMNI) puederesultar una técnica muy útil para el anestesiólogo tantosi su trabajo transcurre en la Unidad de CuidadosCríticos, en la Unidad de Recuperación Postanestésica(URPA), en el quirófano e incluso fuera del áreaquirúrgica. Puede ayudar a tratar situaciones en las quese presente una insuficiencia respiratoria aguda (IRA) opuede prevenir que ésta aparezca en pacientes de riesgosometidos a intervenciones con anestesia loco-regional oen determinadas pruebas diagnóstico-terapéuticas querequieren sedación. La correcta utilización de la VMNIdepende de una adecuada formación del personalsanitario y de una acertada elección del material(interfases, respiradores, etc.) para su realización encada uno de los ámbitos de nuestro trabajo en los quepuede ser útil su puesta en práctica(AU)
Noninvasive ventilation (NIV) can be useful toanesthesiologists working in critical care units,postanesthesia recovery units, operating theaters, orother settings. NIV can help in situations of acuterespiratory failure or serve as a preventive measure inpatients undergoing interventions under local-regionalanesthesia or diagnostic or therapeutic proceduresrequiring sedation. Successful NIV depends onadequately trained health personnel and the properchoice of material (interfaces, respirators, etc.) for eachsetting where this modality is used(AU)
Subject(s)
Humans , Male , Female , Respiration, Artificial/methods , Respiration, Artificial/trends , Anesthesiology/methods , Anesthesiology/trends , Cardiopulmonary Resuscitation/methods , Critical Care/methods , Respiratory Insufficiency/complications , Respiratory Insufficiency/diagnosis , Respiratory Insufficiency/drug therapy , Respiratory Insufficiency/prevention & control , Hypoventilation/complications , Hypoventilation/physiopathologyABSTRACT
Baclofen via intrathecal infusion pump is a widely used treatment severe spasticity. Complications are rare and usually mild, though they can also be serious. The sudden discontinuation of intrathecal baclofen may have significant adverse effects. We report the case of a 59-year-old man with chronic spasticity and torsion dystonia who developed meningitis due to Staphylococcus epidermidis due to contamination of the intrathecal, infusion pump reservoir during refilling. It was decided to treat the patient by administering vancomycin through the pump, together with the baclofen. We believe that changing the intrathecal perfusion pump is not necessary as the first measure to take in these cases. Combined infusion of baclofen and an antibiotic through the pump makes it possible to maintain antispastic treatment, sterilize the pump reservoir and tubes, and effectively treat infections that develop during use of these systems.
Subject(s)
Anti-Bacterial Agents/administration & dosage , Anticonvulsants/administration & dosage , Baclofen/administration & dosage , Infusion Pumps, Implantable/adverse effects , Meningitis, Bacterial/drug therapy , Staphylococcal Infections/drug therapy , Staphylococcus epidermidis , Vancomycin/administration & dosage , Anti-Bacterial Agents/therapeutic use , Anticonvulsants/therapeutic use , Baclofen/therapeutic use , Dystonia Musculorum Deformans/drug therapy , Equipment Contamination , Home Infusion Therapy/instrumentation , Humans , Infusions, Parenteral/instrumentation , Male , Meningitis, Bacterial/etiology , Middle Aged , Staphylococcal Infections/etiology , Vancomycin/therapeutic useABSTRACT
El tratamiento de la espasticidad severa medianteuna bomba programable de perfusión intratecal debaclofeno es una técnica ampliamente extendida. Lascomplicaciones que puede presentar son poco frecuentes,y generalmente leves, si bien también pueden ser deimportante gravedad. Además, la interrupción bruscade la perfusión de baclofeno intratecal puede condicionarimportantes efectos adversos.Presentamos el caso de un varón de 59 años de edadcon espasticidad crónica y distonía muscular deformanteque presentó una meningitis por Staphylococcus epidermidis debida a la contaminación del reservorio de la bomba de perfusión intratecal en uno de los rellenos del mismo. Se decidió tratar al paciente mediante la administración conjunta a través de la bomba de vancomicina junto al baclofeno. En conclusión, creemos que en estos pacientes no es necesario como primera medida el recambio de las bombas de perfusión intratecal. La administración conjunta de baclofeno y antibiótico a través de la bomba permite mantener el tratamiento antiespástico, esterilizar el reservorio y los sistemas de canalización de la misma y tratar eficazmente las infecciones producidas a través de estos sistemas
Baclofen via intrathecal infusion pump is a widely usedtreatment severe spasticity. Complications are rare andusually mild, though they can also be serious. The suddendiscontinuation of intrathecal baclofen may havesignificant adverse effects.We report the case of a 59-year-old man with chronicspasticity and torsion dystonia who developed meningitisdue to Staphylococcus epidermidis due to contamination ofthe intrathecal infusion pump reservoir during refilling. It was decided to treat the patient by administering vancomycin through the pump, together with the baclofen. We believe that changing the intrathecal perfusion pump is not necessary as the first measure to take in these cases. Combined infusion of baclofen and an antibiotic through the pump makes it possible to maintain antispastic treatment, sterilize the pump reservoir and tubes, and effectively treatinfections that develop during use of these systems
